New laser treatment for burn scars at MetroHealth offers hope for North Royalton woman (slideshow and video)

CLEVELAND, Ohio -- On March 20, 2013, Meeta Shah was dry roasting flatbread at the stovetop in her home in North Royalton when a tiny piece of burning food floated up out of the pan and landed on her cotton shirt. In an instant, the shirt was aflame and her daughter, then 8, watched in terror as Shah tried in vain to put out the fire.

Watch as MetroHealth doctor uses new laser to help burn victimsMetroHealth's new Associate Director of the Comprehensive Burn Care Center, Dr. Anjay Khandelwal, uses the new Lumenis Ultra Laser to resurface the skin of burn patient Meeta Shah. MetroHealth is one of the only hospitals in the country to use this powerful new tool.

Shah, 42, survived. But like most burn patients, she was left with physical reminders of that night: thick, whorled scars from third-degree burns on her chin, neck, chest and armpits, and large patches of scarred and discolored skin on her legs where doctors took grafts to replace what had burned away.

The scars bothered Shah-- they were tight and uncomfortable at times and they reminded her of what had happened -- but she was feeling well and had decided to accept her altered appearance. After all, what choice did she have?

Then doctors at MetroHealth Medical Center, where she had spent a month recovering from the burns a year ago, recently gave her another option. It’s a laser treatment called the Lumenis Ultra, which can help improve the appearance, texture and thickness of burn scars, with little pain, even years after an injury.

The treatment appealed to her immediately, Shah said from a hospital bed while awaiting the procedure Tuesday morning.

“I would have to say that I talked my mind into saying that it is what it is, but sometimes it can be better, and now that I have a chance, I’m going to try to have it better,” she said.

Dr. Anjay Khandelwal, Shah’s doctor and the new associate director of MetroHealth’s Comprehensive Burn Center, is the driving force behind this new option at the hospital. Khandelwal, who arrived from Arkansas Children’s Hospital in January, had been using the laser therapy for both adult and pediatric burn patients there with good results for about four years. The treatment has been available, though in a less refined form, since 2009.

When Khandelwal arrived at MetroHealth, he found that the hospital already had a Lumenis laser, but the device was gathering dust in the dermatology department, he said.

“They had it, but they weren’t using it. We were able to acquire the latest software that was released within the last several months, and this is really the ultimate in technology. At this point in time you do not get better than this.”

On Tuesday morning during a 70-minute procedure, Shah was the third burn patient at Metro to undergo the laser treatment.

Burning to heal

Delicate white curls of smoke lifted off Shah’s scarred skin as Khandelwal maneuvered the device and the bright red beam of the laser traced a programmed pattern over each tiny patch of skin. The only sound from the laser is a high-pitched, wasp-like buzzing.

The Lumenis laser is basically a rolling cart with a long flexible arm and a foot pedal. The doctor changes the laser's settings on the cart, moves the laser into place by moving the arm, and activates the laser using the pedal.

Making his way methodically along the thickest parts of the scars along Shah’s neck and chin, Khandelwal explained how the laser works by burning tiny holes, or channels, into the scar tissue.

“[This] does two things. No. 1, it stimulates the healing process from down below. No. 2, because of those holes, those vaporized cylindrical holes, it allows the scar tissue to kind of collapse on itself, which is why we think the scars will decrease in height and they’ll have a much smoother appearance and a more natural appearance.”

The laser has several settings based on different software programs and handheld attachments. Khandelwal uses two penetration depths-- a deep 4 millimeter setting for thick scars and a shallow 1.5 millimeter setting for overall smoothness and coloring—to achieve the best results.

“The shallow setting is what typically a lot of dermatologists will use, mostly in the outpatient setting, for fine lines and wrinkles,” Khandelwal said. “With a combination of the deep feature and the shallow feature, it gives us the ability to treat scars.”

Patients have to be under general anesthesia for the procedure because treating a large area of skin, particularly with the deep setting, would cause too much pain without it. “It would be impossible to do this in the office setting,” Khandelwal said as he finished the deep laser treatments on the thickest scars along Shah’s neck, armpits and leg.

Next, the doctor switched to the shallow setting of the laser, which he and resident Dr. Ji Son applied to all of Shah’s scars in a steady sweeping motion, almost like a spray-paint, by holding the handpiece about four inches above the surface of the skin.

When he was done, the fine pattern of the laser’s burns left a white, mesh-like covering on top of Shah’s scars. The pattern will fade in a couple of days, and results will start to show over the next four to six weeks.

Not a quick fix

There are about 1 million burn injuries in the United States annually, and about 45,000 hospitalizations, mostly in the nation’s 125 burn centers, according to the American Burn Association. Most burn injuries are caused by fires in the home.

Third-degree, or full-thickness burns, destroy the outer layer of skin and all the supporting structures of the skin underneath, and require skin grafts to heal. After the immediate burn crisis care is done and a patient can leave the hospital, it can take up to nine months for the skin to fully heal.

That’s the earliest after an injury Khandelwal would offer the laser treatment, he said. But patients who were burned years ago can still benefit from it, too.

Burn patients who have the laser procedure return every eight weeks for another round of treatment, up to four or five times. Most see an improvement over that time in the appearance and texture of the scars, and in the feeling of tightness and discomfort the thick bands of tissue can cause.

Shah hopes that her scars will be less visible and less prominent, and will blend in more with her natural skin tone.

“Hopefully it will make me more confident to wear sleeveless clothing again,” she said from home two days after the procedure.

Recovery from the procedure is relatively simple. Patients go home the same day, and use over-the-counter medication to manage the pain, which Shah said feels like a bad sunburn.

“I’m definitely feeling pain right now,” she said. “Once I take the medicine I can do my daily activities, though. It’s tolerable. ”

Not a question of vanity

The Lumenis treatment for burn scars is considered a reconstructive procedure, and is covered by insurance for that reason, Khandelwal said. Cosmetic procedures are performed on healthy skin, he pointed out.

“You’ll always be able to tell that they’ve been burned, it’s not going to look perfect," he said. “But you’ll get a much greater benefit.”

The improvements the laser procedure offers can give a powerful confidence boost to people with burn scars who may have been struggling with depression, anxiety, or avoiding social situations.

“They’re very conscious of the burn and it’s not a question of vanity, it’s just a question of ‘my body’s been altered’ and it hurts. The whole process from the very beginning of the burn injury even up to this phase and in the future, that whole thing is going to be a traumatizing experience.”

Khandelwal has seen a lot of positive results with laser treatment, in kids and adults, but said that outcomes vary as much as individual burn patients and often reflect the large emotional and social component of the injury.

“The size of the burn has nothing to do with the psychological trauma the patient sustains. It’s the same thing from the response to the treatment. Some will see very little improvement, but to them it will make a big difference. It’s all individual.”

Khandelwal is thrilled to be able to have something else to offer burn patients, who up until about five years ago would have been left with no options beyond compression bandages, steroid injections and resignation.

“There wasn’t a lot that we could do with the exception of perhaps some big reconstructive surgery, which would entail quite a bit and may very well add to problems and complications,” he said. “So now I can confidently go to a patient and say ‘look, this is not what you’re going to be left with’ and we can improve upon this and make this better.”

Shah had been considering plastic surgery before she heard of the laser option, and is happy she is able to try a less invasive option.

“I had gone to talk to a plastic surgeon, but I wasn’t completely ready with the options that they were offering me,” she said.

Shah is cautiously optimistic, but won’t make any decisions on more treatments until she’s healed up.

“I want to see how I look in eight weeks,” she said, “before I decide how many more treatments I’d be willing to go through.”

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